Reactive Attachment Disorder in Orphans and Vulnerable Children (OVC) Affected by HIV/AIDS: Implications for Clinical Practice, Education and Health Service Delivery

Background: Orphans and vulnerable children (OVC) affected by HIV/AIDS frequently experience placement/ residential changes, inconsistent caregivers, abuse, neglect, disruptions in their lives and several mental health problems. This may lead to a disorder of emotional functioning, reactive attachment disorder (RAD), where the child exhibits wary, watchful, and emotionally withdrawn. Despite its clinical importance, nothing is known about RAD among OVC. This study investigated: (1) whether RAD symptoms can occur in children affected by HIV/AIDS; (2) association between RAD and other psychiatric symptoms; (3) possible aetiological or contextual factors for high RAD symptom; and (4) any interactive, cumulative effects between the aetiological or contextual factors (both risks and protective) for higher RAD symptoms. Method: In a cross-sectional survey, caregivers of 191 OVC and 100 non-OVC completed questionnaires on mental health problems including RAD and contextual variables. Results: The results demonstrated that RAD is present in OVC and that RAD symptoms may be as a result of environmental factors. The study also found high levels of RAD comorbidity with other disorders including depression, conduct problems and hyperactivity. Finally, the results indicate that experiencing more neglect and psychological abuse among OVC increases their likelihood of exhibiting RAD symptoms five-fold. Conclusion: The paper discusses the clinical implications of these findings for service development for this vulnerable group in the community and concluded that among children affected by HIV/AIDS, RAD was not rare.